2021-11-03

Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, 26506, USA. Shitiz.sriwastava@hsc.wvu.edu.; West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA. Shitiz.sriwastava@hsc.wvu.edu.; Department of Neurology, Wayne State University, Detroit, MI, USA. Shitiz.sriwastava@hsc.wvu.edu.; Deaprtment of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Army College of Medical Sciences, New Delhi, India.; Department of Neurology, Berkeley Medical Center, West Virginia University, Martinsburg, WV, USA.; Department of Biostatistics, West Virginia University, Morgantown, WV, USA.; Department of Biostatistics, West Virginia University, Morgantown, WV, USA.; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.; West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA.; Nepal Health Research Council, Kathmandu, Nepal.; Department of Neuropsychiatry, Minia University, Minia, Egypt.; Department of Neurology, Wayne State University, Detroit, MI, USA.; Department of Biochemistry, Microbiology and Immunology, Wayne State University, Detroit, MI, USA.

BACKGROUND: The literature on neurological manifestations in COVID-19 patients has been rapidly increasing with the pandemic. However, data on CNS inflammatory disorders in COVID-19 are still evolving. We performed a literature review of CNS inflammatory disorders associated with coronavirus disease-2019 (COVID-19). METHODS: We screened all articles resulting from a search of PubMed, Google Scholar and Scopus, using the keywords; "SARS-CoV-2 and neurological complication", "SARS-CoV-2 and CNS Complication" looking for reports of transverse myelitis, longitudinally extensive transverse myelitis, neuromyelitis optica, myelitis, Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD), Acute Disseminated Encephalomyelitis (ADEM), Acute Hemorrhagic Necrotizing Encephalitis/Acute Hemorrhagic Leukoencephalitis (AHNE/AHLE), Cytotoxic lesion of the Corpus Callosum/Mild Encephalopathy Reversible Splenium Lesion(CLOCC/MERS) and Optic neuritis published between December 01, 2019 and March

2021-03-24

Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Infectious disease department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA. Electronic address: hesham.abboud@uhhospitals.org.

BACKGROUND: Serious neurological complications of SARS-CoV-2 are increasingly being recognized. CASE: We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. CONCLUSION: Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination.CI - Copyright © 2021 Elsevier B.V. All rights reserved.

Institute of Nuclear Medicine and Allied Sciences, New Delhi 110054, India.; Institute of Medicine, Kathmandu P.O.BOX 1524, Nepal.; Safdarjung Hospital, New Delhi 110029, India.; Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA.; Department of Epidemiology, Fay W. Boozman, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.; Department of Neurology, University of Missouri Healthcare, Columbia, MO 65212, USA.; School of Medicine, West Virginia University, Morgantown, WV 26506, USA.; School of Medicine, West Virginia University, Morgantown, WV 26506, USA.; Department of Neuropsychiatry, Minia University, Minia 61519, Egypt.; Department of Neurology, Berkeley Medical Center, West Virginia University, Morgantown, WV 26506, USA.; Meditrina Institute of Medical Sciences, Nagpur, Maharashtra 440012, India.; Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA.; Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA.; Department of Neurology, Wayne State University, Detroit, MI 48201, USA.

We performed a systematic literature review of neuroimaging, predominantly focusing on magnetic resonance imaging (MRI) findings associated with neurological manifestations of coronavirus disease-2019 (COVID-19). We screened articles from PubMed, Google Scholar and Scopus, looking for reports that would potentially have neuroimaging findings in patients with COVID-19. Data analysis was performed with patient-based data based on the availability of clinical characteristics and outcomes for each individual patient from the studies. Chi square and Wilcoxon rank-sum tests were used to report COVID-19 severity and outcomes based on neurological imaging indicators and pathophysiology. A total of 171 patients with COVID-19 having neurological complications, from 134 studies, were identified in our review. The most common neuroimaging finding was ischemic stroke (62, 36.2%) cases, followed by CNS inflammatory disorder (44, 25.7%), and hemorrhagic stroke (41, 24.0%). Around 51% of all the